Project Summary/Abstract The overall goal of this 2-year R21 collaborative research project is to adapt an existing adult-child interaction coding system for use with dental personnel, parents/caregivers, and child patients to provide an evidence-based method of understanding behavioral interactions in pediatric dental care. The ultimate goal of this line of research is to assess the extent to which oral health professionals rely on a unique set of skills to build rapport, prompt adherence, and manage the behavior of very young children (ages 0 through 5). Two years of funding will be required to examine typical behaviors utilized by dental providers and to test the psychometric properties of this unique, practical coding system within the dental setting. This project will align community- and university-based (faculty and professional staff) dental providers with a research team to assess the effects of dental provider behaviors on outcomes of child compliance, disruptive behavior, parental and child distress, and parental satisfaction. In addition, moderators/mediators (i.e., dental care-related anxiety and fear in both parent/caregiver and child, internalizing and externalizing behaviors) will be assess for possible impact on outcomes, as will environmental factors (e.g., parent proximity), to allow a comprehensive understanding of a child's experience in a dental setting. With an innovative methodology, findings from this project will reveal oral health care providers' responsivity to children's developmental needs in an underutilized population (0-5 years) in both research and real-life dental settings. The valuable connections with community partners in the state of West Virginia and Ohio allow this study to be both feasible and representative of a large variety of dental settings. The project is designed to target a few key skills that could greatly impact child comfort in the dental office and create a foundation for future positive oral health care behaviors. The long- term goal is to translate identified skills into a simple training package that will be useful for dental providers to reduce distress in very young children and increase positive early experiences with oral health care. Specifically, the ultimate intent is to create a concise, effective skills training framework for all dental providers to increase developmentally-appropriate behaviors for the youngest patients in the dental setting.